Exploring the mesenteric lymphatic apparatus: A morphological and immunohistochemical investigation with clinical correlations.

Modern immunohistochemical techniques allow a detailed study of the lymphatic system in many organs and areas of the body. We performed an in-depth study on lymphatic vessels of the ileal and colonic mesenteries, together with the greater omentum where they appear particularly numerous and mainly represented by capillaries interconnected among themselves and with lymph nodes. The capillary wall consists of a fine single sheath of endothelial cells wrapped around by a subtle collagen membrane and deprived of valves. The progression of lymph flow is promoted by external forces acting on the capillary walls. Only at the mesenteric roots can pre- and post-lymph nodal collector vessels be observed. Our observations help to explain different patho-physiological correlations and the possible presence of skip lymph node metastases.

Deep inside of gastric signet-ring cell carcinoma.

The histology of signet-ring cell carcinoma (SRC) of the stomach has been revisited with the support of current immuno- histochemical techniques in order to explain particular features of this tumor; its great capacity of local diffusion and lymph node metastasis, also through a neo-lymphoangiogenesis. An observational retrospective study on 50 cases of SRC in stage II and III has been performed with the addition of histochemical (Alcian Blue, DDD-Fast Blue B, Mercury Orange) and immunohistochemical (cytocheratin, CD3, CD4, CD8, CD10, CD56, CD68, perforin, granzyme B, podoplanin, collagen type IV) investigations for each case. The signet ring cells, typical for this tumor, show abundant content of electro-negative sialomucins and demonstrate a great capacity of diffusion through the gastric wall. They evoke production and deposition of collagen type IV in the sub-mucosa layer through the local action of fibroblasts. The immunological response to this tumor in the gastric wall and in the metastatic lymph nodes is represented by an increase of B and T-helper lymphocytes, but not of T-killers or natural killers. The neoplastic cells are curiously able to avoid these newly formed 'lymph nodules'. An extended neo-lymphangiogenesis has been observed around the primary tumor and in metastatic lymph nodes. A careful immunohistochemical characterization has allowed a better knowledge of SRC, regarding especially the peculiar behavior of local diffusion of its cells, the associated neo-lymph angiogenesis, and poor immunological reaction.

Image-Guided Proper Liver Segmentectomy.

BACKGROUND: The new cross-sectional radiological tools, 3D computed tomography and magnetic resonance, allow a precise study of the liver anatomy. Thanks to these imaging techniques, a new space inside the liver parenchyma, the "hepatic core," was recently recognized, where the hila of liver segments are present. METHODS: On the basis of anatomical and radiological observations, we identified a new virtual plane of dissection, named "hepato-portal," which is useful in liver segmentectomy, if integrated with the classical planes of dissection. RESULTS: Simulated surgical procedures can be intra-operatively transferred by ultrasounds. In this way, we performed ten "proper" liver segmentectomies through preliminary sections of the hilar vessels and a precise dissection of the boundaries of each segment. CONCLUSIONS: Our experience underlines the value of integrating anatomy and radiology in the simulated liver surgery.

Sea buckthorn bud extract displays activity against cell-cultured Influenza virus.

INTRODUCTION: Vaccines and antiviral drugs are the most widely used methods of preventing or treating Influenza virus infection. The role of sea buckthorn (SBT) bud dry extract as a natural antiviral drug against Influenza was investigated. METHODS: Influenza virus was cultured in the MDCK cell line, with or without SBT bud extract, and virus growth was assessed by HA and TCID50 virus titration in terms of cytopathic effect on cells. Several concentrations of extract were tested, the virus titer being measured on day 4 after infection. RESULTS: After infection, the virus titer in the control sample was calculated to be 2.5 TCID50/ml; treatment with SBT bud extract reduced the virus titer to 2.0 TCID50/ml at 50 µg/ml, while the HA titer was reduced from 1431 (control) to 178. Concentrations lower than 50µg/ml displayed an inhibitory effect in the HA assay, but not in the TCID50 virus titration; however, observation of the viral cultures confirmed a slowdown of viral growth at all concentrations. DISCUSSION: Natural dietary supplements and phytotherapy are a growing market and offer new opportunities for the treatment of several diseases and disorders. These preliminary experiments are the first to show that SBT bud extract is able to reduce the growth of the Influenza A H1N1 virus in vitro at a concentration of 50 µg/ml. This discovery opens up the possibility of using SBT bud extract as a valid weapon against Influenza and, in addition, as the starting-point for the discovery of new drugs.

Flexibility and pragmatism in promoting health: an experience of synergy between health and religion in the Islamic Republic of Iran.

In the Islamic Republic of Iran, religion has traditionally played a central role in the lives of the people. Following the Islamic Revolution in 1979, it has also become integral to the country's governance. Since the Revolution, an exceptional synergy has arisen between the domain of religion and the health sector in the development of family planning policies, which have resulted in dramatic changes in population growth and fertility: the population growth rate decreased from 3.9% (1986) to 1.2% (2000) and total fertility from 6.8 (1984) to 2.1 (2000). The extraordinary aspect of this experience is that the position of religious authorities changed from one of opposition to one of active promotion of family planning. This paper describes the establishment and course of family planning programmes in Iran and makes use of interviews with two main protagonists of this experience (Dr Alireza Marandi--Minister of Health 1984-1989, 1993-1997; Dr Hossein Malekafzali--former Deputy Minister of Health). It is hoped that dissemination of this experience outside of the Islamic Republic of Iran will encourage the development of similar dialogue and synergy between religion and health in other countries.

3-T MRI with phased-array surface coil in the local staging of rectal cancer.

PURPOSE: This study sought to evaluate the diagnostic accuracy of surface-coil 3T magnetic resonance (MR) imaging in the preoperative study of patients with rectal cancer. MATERIALS AND METHODS: Thirty patients with histologically proven rectal cancer underwent surface-coil 3T MR imaging with sagittal, paracoronal and para-axial T2-weighted turbo spin echo (TSE) sequences. Slice thickness was 3 mm without gap, field of view 24 cm, matrix 400 × 512. Images were assessed for infiltration of the rectal wall, perirectal fat and pelvic structures. Tumours were staged according to the TNM system, and the MR imaging results were correlated with histopathology. RESULTS: In the patients who underwent MR imaging before and after radiotherapy (group 1), the diagnostic accuracy of 3T MR imaging was 88% for T2, 94% for T3 and 88% for T4 cancers. In those who underwent surgical treatment without preoperative radiotherapy (group 2), the diagnostic accuracy was 90% for T2, 87% for T3 and 87% for T4 cancers. CONCLUSIONS: The high signal-to-noise ratio coupled with a large field of view enables surface-coil 3T MR imaging to achieve high levels of diagnostic accuracy in the local staging of rectal cancer, and in particular in assessing infiltration of mesorectum and mesorectal fascia.

Omental transposition after right hemicolectomy.

A radical hemicolectomy is often followed by large retroperitoneal dissection. An adequate omental transposition allows for easy peritoneal coverage of all the dissected areas.